Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis

Zeng, Yiqian; Zeng, Weizhong; Yang, Bihui; Liu, Zhao

doi:10.1016/j.medcli.2022.03.013

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…These were associated with an 18 and 61% reduction in overall mortality, respectively. This finding was generally consistent with the body of evidence as a clinical trial reported similar protective effects of corticosteroids (OR = 0.83) on COVID-19 (41), and pooled meta-analysis showed the same effect size (OR = 0.88) (42). Furthermore, our study revealed that methylprednisolone and hydrocortisone, two other corticosteroids prescribed steadily in approximately 10% of cases during the study period, were associated with a higher risk of mortality, being 2.06 and 1.65 times higher, respectively.…”

Section: Discussionsupporting

confidence: 89%

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

Mehrizi,

Golestani,

Malekpour

et al. 2023

Front. Public Health

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BackgroundDifferent medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran.MethodsWe retrieved hospitalized patients’ data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020–2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models.ResultsDuring the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74–55.94]), corticosteroids (54.14% [54.04–54.24]), and antibiotics (42.22% [42.12–42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94–0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73–0.76]), corticosteroids (0.97 [0.95–0.99]), antivirals (0.82 [0.80–0.83]), and ACE inhibitor/ARB (0.79 [0.77–0.80]) were significantly associated with lower mortality.ConclusionOver 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.

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Section: Discussionsupporting

confidence: 89%

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

Mehrizi,

Golestani,

Malekpour

et al. 2023

Front. Public Health

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“…However, treatment with corticosteroids is debated in COVID-patients and the most effective type of corticosteroid treatment is another concern that needs to be addressed. Therefore, there is an urgent need for more RCTs to confirm and validate previous findings [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Mild COVID-19 in an APECED Patient with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and High Titer of Type 1 IFN-Abs: A Case Report

et al. 2023

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Autoimmune-Poly-Endocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED), caused by mutations in the Autoimmune Regulator (AIRE) gene, is an autosomal recessive multi-organ autoimmunity syndrome usually defined by high serum titers of type I Interferon Autoantibodies (Type 1 IFN-Abs). These antibodies have recently been found in individuals in the general population who develop life-threatening Coronavirus Disease 2019 (COVID-19), but the significance of pre-existing Type 1 IFN-Abs in APECED patients with COVID-19 remains unclear. Previous reports of COVID-19 outcomes in APECED patients have been divergent, and protective roles have been proposed for female sex, age <26 years, and immunomodulatory medications including intravenous immunoglobulin (IVIg). We report the case of a 30-year-old male APECED patient who experienced a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection with mild symptoms of fatigue and headache without respiratory distress and did not require hospitalization. He received a stress dose of hydrocortisone for adrenal insufficiency and continued on his baseline medications, including subcutaneous administration of Immunoglobulins (SCIgs) for chronic inflammatory demyelinating polyneuropathy (CIDP). Mild COVID-19 in a 30-year-old male patient with APECED and pre-existing Type 1 IFN-Abs was unexpected. Younger age and management of autoimmunity may have played a role.

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“…The ACE-2 receptor is expressed on epithelial cells of the gastrointestinal tract, kidneys, vascular endothelial cells, and adipose tissues among many other organs, and this vast array of distribution leads to profuse clinical signs and symptoms. In the severe stages of the disease, high levels of circulating cytokines and chemokines augment the viral process of pneumonia, acute respiratory distress syndrome, sepsis, coagulopathy, and other severe complications of COVID-19 23 . The treatment of choice has usually been corticosteroids, to reduce lung inflammation but recent evidence implies that it delays viral clearance with no effect on mortality but depends on the severity of the disease 24 .…”

Section: Discussionmentioning

confidence: 99%

“…D-dimer is a coagulation parameter that can help in detecting early DIC, indicating a hypercoagulable state, and a high risk of thrombosis 21 . Postmortem studies reveal d-dimer elevation has been linked to coagulopathy and with DIC, developing into capillary microthrombosis 23 . Patients with COVID-19 and comorbidities spend a longer duration in an immobile state and are more likely to undergo an invasive procedure leading to the possibility of a thrombotic episode 3 .…”

Section: Discussionmentioning

confidence: 99%

Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort

Tahir

Yasmin

Naeem

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction D-dimer levels, which originate from the lysis of cross-linked fibrin, are serially measured during coronavirus disease 2019 illness to rule out hypercoagulability as well as a septic marker. Methods This multicenter retrospective study was carried out in two tertiary care hospitals in Karachi, Pakistan. The study included adult patients admitted with a laboratory-confirmed coronavirus disease 2019 infection, with at least one measured d-dimer within 24 h following admission. Discharged patients were compared with the mortality group for survival analysis. Results The study population of 813 patients had 68.5% males, with a median age of 57.0 years and 14.0 days of illness. The largest d-dimer elevation was between 0.51–2.00 mcg/ml (tertile 2) observed in 332 patients (40.8%), followed by 236 patients (29.2%) having values greater than 5.00 mcg/ml (tertile 4). Within 45 days of hospital stay, 230 patients (28.3%) died, with the majority in the ICU (53.9%). On multivariable logistic regression between d-dimer and mortality, the unadjusted (Model 1) had a higher d-dimer category (tertile 3 and tertile 4) associated with a higher risk of death (OR: 2.15; 95% CI: 1.02–4.54, P=0.044) and (OR: 4.74; 95% CI: 2.38–9.46, P<0.001). Adjustment for age, sex, and BMI (Model 2) yields only tertile 4 being significant (OR: 4.27; 95% CI: 2.06–8.86, P<0.001). Conclusion: Higher d-dimer levels were independently associated with a high risk of mortality. The added value of d-dimer in risk stratifying patients for mortality was not affected by invasive ventilation, ICU stays, length of hospital stays, or comorbidities.

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Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis

Cited by 8 publications

References 25 publications

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

Mild COVID-19 in an APECED Patient with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and High Titer of Type 1 IFN-Abs: A Case Report

Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort

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